Admin_Adham
TOPLINE
Mechanically ventilated infants who failed weaning had significantly lower diaphragmatic thickness at inspiration and diaphragm thickening fraction (DTF), and higher rapid shallow breathing index (RSBI), compared with successfully weaned infants.
METHODOLOGY
- A prospective observational study (January 2024-January 2025) included 40 mechanically ventilated infants aged 28 days to 12 months admitted to a pediatric ICU in Egypt.
- Participants underwent transthoracic ultrasound assessment during a spontaneous breathing trial using pressure support ventilation; diaphragmatic thickness at inspiration and expiration, DTF, RSBI, inferior vena cava diameter, and contractility were measured.
- The primary outcome was weaning failure, defined as the requirement for post-extubation noninvasive ventilation or reintubation within 24-72 hours after extubation; successful weaning was defined as successful extubation without either intervention during the same period.
- Weaning failure occurred in 6 infants (15.0%) and successful weaning was documented in 34 infants (85.0%).
TAKEAWAY
- Diaphragmatic thickness at inspiration was significantly lower in infants with weaning failure compared with those successfully weaned (median, 1.65 mm vs 1.83 mm; P < .001).
- DTF was markedly lower in the weaning failure group compared with the successful weaning group (median, 12.0% vs 26.0%; P < .001).
- RSBI was significantly higher in infants who failed weaning compared with those who were successfully weaned (P < .001).
- Receiver operating characteristic (ROC) analysis showed that area under the curve diaphragmatic thickness at inspiration demonstrated near-perfect discrimination (area under the curve, 0.998; P < .001), with an optimal cutoff of ≤ 1.69 mm yielding 100.0% apparent sensitivity and 97.1% apparent specificity.
IN PRACTICE
"[The study] findings suggest that dynamic measures of diaphragmatic recruitment and respiratory load during spontaneous breathing may be more clinically informative than static or volume-based measurements for assessing weaning readiness in mechanically ventilated infants," the authors wrote.
SOURCE
The study was led by Marwa Ibrahem Abdelrazic, Department of Pediatrics, Faculty of Medicine, Minia University in Minya, Egypt. It was published online on August 18 in European Journal of Pediatrics.
LIMITATIONS
This single-center study had a small sample size with only 6 weaning failure events, limiting statistical power and increasing the risk for unstable estimates, particularly for ROC-derived cutoffs. Ultrasound measurements may be operator-dependent, and intraobserver and interobserver reliability could not be evaluated. The spontaneous breathing trial was performed using pressure support ventilation rather than a T-piece, and exact pressure support and positive end-expiratory pressure levels were neither protocolized nor prospectively recorded.
DISCLOSURES
Open access funding was provided by The Science, Technology & Innovation Funding Authority in cooperation with The Egyptian Knowledge Bank. The authors reported no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
